GASTROINTESTINAL MOTILITY AND SENSORY ABNORMALITIES MAY CONTRIBUTE TO FOOD REFUSAL IN MEDICALLY FRAGILE TODDLERS – מתוך כנס גאסטרו ילדים, 9 ביולי 2002


Tsili Zangen, MD, Carla Ciarla, MD, Samuel Zangen, MD ,Carlo Di-Lorenzo, MD, Lenore Schwankovski, PhD, Paul Hyman , MD. Schneider Children's Medical Center Israel, CHOC Orange CA USA

ABSTRACT In chronically ill children who refuse to eat, surgery to correct anatomic problems and behavioral treatments to overcome oral aversion often succeed. A few patients fail with standard treatments. The aims of the study were to: 1) investigate motility and gastric sensory abnormalities and 2) describe treatment that was individualized based on pathophysiology in children who failed surgery and behavioral treatments.We studied 14 patients (age 1.5-6; mean 2.5; M/F: 7/7). Eleven of 14 were developmentally delayed. Nine of 11 had sensitizing perinatal experiences(ex-premies). All had a lifelong history of food aversion and retching or vomiting persisting after feeding therapy and fundoplication. All were fed through gastrostomy or gastro-jejunostomy tubes. We studied esophageal and antroduodenal manometry, and gastric volume threshold for retching. We identified when gastric antral contractions were associated with retching and pain. A multi-disciplinary treatment program included a variable combination of continuous post-pyloric feedings, drugs to decrease visceral pain, drugs for motility disorders, and behavioral, cognitive, and family therapy. We interviewed parents 2-6 months following testing to evaluate symptoms, mode of feeding and emotional health.We found a motility disorder alone in 2, decreased threshold for retching alone in 5 and both motility and sensory abnormalities in 7. After treatment, 6 of 14 (43%) began eating orally and 80% had improved emotional health. Retching decreased from 15 episodes/day to an average of 1.4 per day (p < 0.01).Upper gastrointestinal motor and/or sensory disorders contributed to persistent feeding problems in these children. A multi-disciplinary approach improved symptoms and quality of life for a majority of children with persistent feeding problems.

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